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ObjectiveTo describe the patient characteristics, diagnoses and clinical outcomes of patients presenting with acute upper gastrointestinal bleeding (AUGIB) in the 2007 UK Audit.DesignMulti-centre survey.SettingAll UK hospitals admitting patients with AUGIB.ParticipantsAll adults (>16 years) presenting in or to UK hospitals with AUGIB between 1 May and 30 June 2007.ResultsData on 6750 patients (median age 68 years) was collected from 208 participating hospitals. New admissions (n=5550) were younger (median age 65 years) than inpatients (n=1107, median age 71 years), with less co-morbidity (any co-morbidity 46% vs 71%, respectively). At presentation 9% (599/6750) had known cirrhosis, 26% a history of alcohol excess, 11% were taking non-steroidal anti-inflammatory drugs and 28% aspirin. Peptic ulcer disease accounted for 36% of AUGIB and bleeding varices 11%. In 13% there was evidence of further bleeding after the first endoscopy. 1.9% underwent surgery and 1.2% interventional radiology for AUGIB. Median length of stay was 5 days. Overall mortality in hospital was 10% (675/6750, 95% CI 9.3 to 10.7), 7% in new admissions and 26% among inpatients. Mortality was highest in those with variceal bleeding (15%) and with malignancy (17%).ConclusionsAUGIB continues to result in substantial mortality although it appears to be lower than in 1993. Mortality is particularly high among inpatients and those bleeding from varices or upper gastrointestinal malignancy. Surgical or radiological interventions are little used currently.

Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. Vitamin K deficiency bleeding (VKDB) in infancy is classified according to the time of presentation: early (within 24 h), classic (within 1 week after birth), and late (between 2 week and 6 months of age). VKDB in infancy, particularly late-onset VKDB, can be life-threatening. Therefore, all infants, including newborn infants, should receive vitamin K prophylaxis. Exclusive breastfeeding and cholestasis are closely associated with this deficiency and result in late-onset VKDB. Intramuscular prophylactic injections reduce the incidence of early-onset, classic, and late-onset VKDB. However, the prophylaxis strategy has recently been inclined toward oral administration because it is easier, safer, and cheaper to administer than intramuscular injection. Several epidemiological studies have shown that vitamin K oral administration is effective in the prevention of VKDB in infancy; however, the success of oral prophylaxis depends on the protocol regimen and parent compliance. Further national surveillance and studies are warranted to reveal the optimal prophylaxis regimen in term and preterm infants.

Background and aims Small bowel bleeding poses a significant diagnostic challenge for clinicians, and capsule endoscopy is currently considered the investigation of choice for evaluating suspected cases. However, evidence regarding the role of second-look endoscopy before capsule endoscopy is limited. This study aimed to evaluate capsule endoscopy findings after a negative second-look endoscopy in patients with suspected small bowel bleeding at a tertiary care center in Sri Lanka. Method This retrospective cross-sectional study analyzed data from patients who underwent capsule endoscopy for suspected small bowel bleeding at the National Hospital of Sri Lanka from June 1, 2018, to March 31, 2023. All patients had negative results on second-look endoscopies and abdominal imaging (CT, MRI, Enterography). The principal investigator reassessed all the capsule recordings at 3–6 frames per second in single-image viewing mode. The study primarily evaluated demographic data, capsule endoscopy findings, and mucosal visualization. Continuous variables were presented as mean ± standard deviation or median. Comparisons for continuous variables were performed using independent-sample t-test and categorical variables were compared using the chi-square test. A two-sided p-value < 0.05 was considered statistically significant. Results The sample size was 71, with a mean age of 54.41 ± 18.44 years. 60.6% of patients were males. Overt bleeding occurred in 52.1% of patients, while occult bleeding occurred in 47.9%. The mean small intestine transit time was 5:16:30 ± 1:48:01 h. Hemoglobin was significantly lower ( p  < 0.001) in patients with overt bleeding, with a mean level of 9.27 ± 1.27 g/dL. Capsule endoscopy identified 30 patients (42.3%) with a definite cause for small bowel bleeding and 22 patients (31.0%) with a probable cause, resulting in an overall diagnostic yield of 73.2%. The proximal small intestine was the most commonly affected segment of the small bowel in cases of small bowel bleeding, accounting for 33 patients (46.5%). None of the patients had lesions in the endoscopically accessible sites of the upper or lower gastrointestinal tract. We noted vascular findings in 18 patients (25.4%), with inflammatory findings accounting for the majority ( n  = 30/42.3%). The predominant treatment option was medical management (71.8%), followed by endoscopic interventions (26.8%) and interventional radiological interventions (2.8%). The number of polyethylene glycol sachets used for bowel preparation did not affect the diagnostic yield or mucosal visualization quality. Conclusion Capsule endoscopy demonstrated a high diagnostic yield in Sri Lankan patients with suspected small bowel bleeding who had normal initial and second-look endoscopies. The proximal small intestine was the commonest involved segment, and, contrary to previous studies, inflammatory lesions were the predominant finding. We recommend low-volume bowel preparation as the number of polyethylene glycol sachets did not affect the diagnostic yield or quality of mucosal visualization. This study supports integrating capsule endoscopy into routine clinical practice for evaluating gastrointestinal bleeding and recommends performing a second-look endoscopy before proceeding to capsule endoscopy.

The search for hereditary bleeding disorders (HBD) prior to invasive procedures in children is primarily based on personal and family bleeding history. Although several scores are available, they have only been evaluated in specific situations or in adults. Our monocentric retrospective study aimed to analyze the association between clinical history and four scores (HEMSTOP, PBQ, ISTH-BAT, TOSETTO) and the diagnosis of MHC in children referred to the University Hospital of Montpellier for hemostasis investigations. A total of 117 children were retrospectively included in the study. Of these, 57 (49%) were diagnosed with HBD, with 30 having primary bleeding disorders and 27 having coagulation disorders. The diagnosis of HBD was significantly associated with gingival bleeding, which was present in 30% of HBD patients. In our population, only the HEMSTOP score showed an association with the diagnosis of HBD, but it was positive in only 48% of patients. By including gingival bleeding as a factor, we modified the HEMSTOP score, which increased its sensitivity from 0.45 to 0.53. When examining primary bleeding disorders, the modified HEMSTOP score, with the inclusion of gingival bleeding, enables us to diagnose 63% of patients (see Fig.  1 ).    Conclusion : Therefore, gingival bleeding should be considered a useful factor in bleeding history for HBD diagnosis. Adding this symptom to a screening score such as HEMSTOP improves its sensitivity. To confirm our findings, a prospective study is required.    Trial registration : Study registration number: NCT05214300. What is Known: • Screening for hereditary bleeding disorder diseases is a necessity and a challenge in children. • Minor disorders of primary hemostasis are the most common, but often escape standard coagulation tests. What is New: • Gingival bleeding is a frequent symptom that is easy to investigate and may point to a primary hemostasis disorder. • Adding the gingival bleeding item to a routine screening score such as HEMSTOP improves sensitivity.

BackgroundHybrid endoscopic submucosal dissection (ESD) incorporates snare-assisted resection to reduce technical difficulty and perforation risk in anatomically complex colon lesions. The All In OneTM (AIO) snare probe, which integrates an ESD knife, needle injector, snare, and argon gas spray - facilitates complete lesion removal using a single instrument during hybrid ESD. This study aims to evaluate the efficacy and safety of the AIOTM snare probe for large colorectal polyp during hybrid ESD.MethodsThis prospective single-arm multicenter trial enrolled patients from five clinical centers between November 2021 and November 2022, who presented with sessile, sub-pedunculated, or broad-based polyp measured 1–3 cm in diameter. All patients underwent hybrid ESD assisted by the AIOTM device. The primary outcome was the en bloc resection rate. The secondary outcomes were complete resection rate, hemostasis success rate, device-related adverse events, intraoperative/postoperative bleeding and perforation occurrences.ResultsA total of 161 patients ultimately enrolled in the study, with 173 target polyps removed by AIOTM (IDDF2025-ABS-0051 figure 1). The average polyp diameter was 1.42 ± 0.47 cm (range 1–3 cm). The en bloc resection rate was 94.8% (164/173) (95% CI: 90.4% - 97.6%). The complete resection rate was 95.4% (165/173) (95% CI: 91.1% - 98.0%), and the hemostasis success rate was 94.2% (163/173) (95% CI: 89.6% - 97.2%). Device-related adverse events occurred in 1.2% (2/161) of patients, both cases involving delayed bleeding. No intraoperative perforation or delayed perforation was reported.Abstract IDDF2025-ABS-0051 Figure 1ConclusionsIn this study, we demonstrated that the AIOTM device achieved favorable efficacy and safety during hybrid ESD procedures. Further large-scale studies are needed.

Capsule endoscopy (CE) is a widely used medical imaging tool for the diagnosis of gastrointestinal tract abnormalities like bleeding. However, CE captures a huge number of image frames, constituting a time-consuming and tedious task for medical experts to manually inspect. To address this issue, researchers have focused on computer-aided bleeding detection systems to automatically identify bleeding in real time. This paper presents a systematic review of the available state-of-the-art computer-aided bleeding detection algorithms for capsule endoscopy. The review was carried out by searching five different repositories (Scopus, PubMed, IEEE Xplore, ACM Digital Library, and ScienceDirect) for all original publications on computer-aided bleeding detection published between 2001 and 2023. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) methodology was used to perform the review, and 147 full texts of scientific papers were reviewed. The contributions of this paper are: (I) a taxonomy for computer-aided bleeding detection algorithms for capsule endoscopy is identified; (II) the available state-of-the-art computer-aided bleeding detection algorithms, including various color spaces (RGB, HSV, etc.), feature extraction techniques, and classifiers, are discussed; and (III) the most effective algorithms for practical use are identified. Finally, the paper is concluded by providing future direction for computer-aided bleeding detection research.

The severity of bleeding events is heterogeneously defined during peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). We studied three bleeding definitions in pVA-ECMO: the Extracorporeal Life Support Organization (ELSO)-serious bleeding, the Bleeding Academic Research Consortium (BARC), and the universal definition of postoperative bleeding (UPDB) classifications. We included consecutive adult patients supported by pVA-ECMO for refractory cardiogenic shock admitted to Lille academic hospitals between January 2013 and December 2019. We assessed the association of bleeding definitions with the primary endpoint of 28-day all-cause mortality with the use of multivariate models accounting for time-dependent and competing variables. We compared models' performances using the Harrell's C-Index and the Akaike information criteria. Twenty-eight-day mortality occurred in 128/308 (42%) 308 patients. The ELSO-serious bleeding (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.09 to 2.56) and BARC ≥ type 2 (HR, 1.55; 95% CI, 1.01 to 2.37) were associated with 28-day mortality (Harrell's C-index, 0.69; 95% CI, 0.63 to 0.74 for both). Predictors of ELSO-serious bleeding were postcardiotomy, body mass index, baseline platelets count, fibrinogen, and hemoglobin levels. Extracorporeal Life Support Organization-serious bleeding and BARC ≥ type 2 are relevant definitions of major bleeding regarding their association with mortality in critically ill patients who survived the first 24 hr while supported with pVA-ECMO for cardiogenic shock. CERAR (IRB 00010254-2022-050, Paris, France); first submitted on 18 April 2022.